Fulminant Hepatic Failure as a Risk Factor for Cytomegalovirus Infection in Children Receiving Preemptive Therapy after Living Donor Liver Transplantation

Background Cytomegalovirus (CMV) is one of the most common causes of infection after solid organ transplantation with symptomatic disease occurring at an incidence of 20% to 40% without preventative measures. Although CMV donor+/recipient-serostatus is well known to be a risk factor, there is little data about other risk factors for CMV infection in the setting of pediatric liver transplantation (LT). We hypothesized that fulminant hepatic failure (FHF) may be a risk factor for CMV infection given anecdotal reports of complications associated with FHF. Methods We conducted medical chart review of children who underwent LT at a tertiary children's hospital in Tokyo between November 2005 and October 2015. We evaluated the risk factors, especially FHF, and prognosis for CMV infection under preemptive therapy. Results Three hundred thirty-seven living donor LT were analyzed. Underlying diseases were cholestatic liver disease (n = 172, 51%), metabolic disease (n = 59, 18%), and FHF (n = 51, 15%). Among 337 LT, 147 (44%) recipients developed CMV antigenemia. In multivariate analysis, FHF (odds ratio, 4.99; 95% confidence interval, 1.86-13.40; P = 0.001) and CMV serostatus were independent risk factors for developing CMV antigenemia. Positive donor serostatus was significantly associated with development of antigenemia within 1-year post-LT regardless of recipient serostatus (P <0.001). On the other hand, positive recipient status was associated with CMV antigenemia in the first 21 days (P <0.001). Only 12 (3.6%) of 337 children developed CMV disease. Conclusions Fulminant hepatic failure was found to be a risk factor for CMV infection independent of CMV serostatus.